How to Choose the Right Group Health Insurance Policy?


How to Choose the Right Group Health Insurance Policy

Group health insurance is one of the most economical health insurance that is available as it covers the employees and their families for a specific sum insured without the need of paying the premium. The employer pays the premium on employee’s behalf and the premiums are quite affordable as the policies are issued in large numbers.

As per the Ministry of Home Affairs new guidelines, it is now mandatory for all the employers to provide medical insurance coverage to their employees on if they resume operations after the COVID-19 lockdown.  So, if you are planning to get a group health insurance cover, you can consider the below-mentioned tips in order to choose the right health insurance policy for your employees:

1. Selecting the Adequate Coverage Amount:

Sum insured or the coverage amount is the maximum amount of money that is paid by the insurance company for medical expenses incurred on the insured employee. Medical inflation should be taken into the consideration, which is higher than the overall inflation of the country. Choose a sum insured amount that can help your employees meet the emergency hospitalization cost.

The premium for a Rs 1 lakh and Rs 3 lakh would not vary much. If you calculate the cost for a higher sum insured amounts and the additional cost that the employee will have to pay, buying a higher coverage amount would probably be more adequate. For group health insurance, typically a sum insured Rs 3 lakh should be provided in case of Tier-1 and Metro cities, and if the coverage is extended to family members then a sum insured of Rs 5 lakh or Rs 7 Lakh should be considered.

2. Network Hospitals

These are the hospitals that are registered with the insurer and offer cashless medical treatment in these empaneled hospitals. Check of the city’s multispecialty hospitals and covered in the group health insurance cover that you are opting for. The wider the list of network hospitals the better it will be. For e.g. the list of network hospitals by HDFC Ergo General Health Insurance is more than 10,000 and Star Allied and Health Insurance provides cashless treatment in nearly 9900 hospitals. And this varies from one insurer to another.

3. Minimum Waiting period or Waiver of Waiting Period

The waiting period is time period offered to the insured employees after which the expenses are covered. Usually, the waiting period is of three types:

  • Initial Waiting Period: Most of the insurance companies provide a waiting period of 30 days, during which the policyholder cannot file a claim for any illness or disease. During this time accidental hospitalization expenses are covered.
  • Waiting Period for Specific Disease: Some diseases like degenerative age-related illness
  • Waiting Period for Pre-Existing Diseases: It usually ranges from 24 months to 36 months in most of the group health insurance plans. If the insured employee filed a health insurance claim for hospitalization required due to pre-existing conditions like diabetes, blood pressure, thyroid, etc. that exist at the time of policy inception. All the insurance providers cover the medical arising from these conditions only after the completion of the waiting period.

But if you are buying a group health insurance plans then you can get the waiting period to waive off by paying an additional premium. It is highly recommended to buy a group health plan with a waiver of waiting periods. It is one of the most distinctive and useful features that group health insurance policies have over a basic mediclaim policy.

4. Room Rent Limit

In metro cities, the cost of a single private room is above Rs 8000 per day. And if you are providing health insurance cover of Rs 3 lakh and the room rent limit is 1% of the coverage amount, then the employee only gets coverage up to Rs 3000 for the room, which does not serve the purpose.

For your employees, try and choose the upper room rent limit or room without sub-limits, so they do not have to pay a hefty amount from their own pocket. Try and opt for a single private room cover in your group health insurance policy.

5. Coverage for the Employee’s Family

If you are planning to extend coverage to the family members of your employees then the premium would be on a higher side. A lot of employees prefer this, infect would appreciate having their family members covered under the same as they do not have to buy a separate health plan for them. You need to decide if you are willing to pay a higher premium then only get the families of your employees covered under the same plan.

6. Maternity Cover

Most of the group health insurance plans provide maternity cover, and it is highly recommended for the employer to ensure that their employees have insurance cover in case of maternity hospitalization. If you have higher number of employees then you must check for this cover. And if you have a smaller team and most of the staff is old or is unmarried then you might skip this one.

In short,

As the cost of healthcare is increasing significantly, and amid the ongoing Coronavirus pandemic, it will be a great effort on your part if you can provide health coverage to your employees. To suit their insurance needs, you can always have your group health insurance tailor-made to cater to their needs. You can also discuss this with your insurance advisor and get your employees insured, especially if you are calling them post COVID-19 lockdown.

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